Becoming More Efficient While Tackling a Total Catheterization Lab Redesign

Rather than simply upgrade the vascular x-ray technology, we decided to make a fresh start by redesigning the entire cardiac catheterization and interventional radiology lab. While we planned the foundation of our updated lab to be a dual-plane vascular x-ray system, the project also would include a comprehensive lab redesign. Our goal was to improve efficiency through the creation of a modern dual lab for diagnosing and treating a wide range of heart and vascular conditions. Our hope was that the new system and lab redesign would enable us to draw the attention of referring physicians and patients in the area. Choosing Equipment for the Lab Our first step was to select imaging equipment for the lab that would offer the best working environment possible and accommodate the needs of radiologists, cardiologists and vascular surgeons in one room. Several of our physicians were familiar with the Infinix DP-i/FD2 (Toshiba America Medical Systems, Tustin, CA) installed at one of our other facilities, St. Joseph Medical Center in Tacoma, Washington, and were eager to get the same system installed here. With our system selected, we moved on to conceptualizing and developing a timeline for constructing our new lab. However, we have only one procedure room at St. Francis and could not afford to have it down for an extended period of time. This left us with only eight weeks to complete the entire project. Given this demanding timeline and high expectations for the room’s design, we assembled a project team of hospital staff, architects and our vendor representatives to manage the process. In addition, we implemented weekly construction meetings to make sure everyone was fully informed and understood their roles throughout the entire process. Thinking Lean In preparation for remodeling the cath/specials lab and installation of the new imaging equipment, we needed to address many of the inefficiencies in our existing facility and capitalize on lessons learned. Using a process called Lean, a methodology adopted by healthcare facilities across the nation, our staff and efficiency-design consultants set out to study the workflow in the existing cath lab. Goal-setting, planning, solution brainstorming and implementation were accomplished during a four-day workshop. Results quickly followed. After reviewing our existing process, the construction team set out to design a facility that would dramatically decrease staff time and motion, improve overall workflow and optimize efficiency. While the team agreed that easy access to the new system should be a primary focus of the redesign, we carefully considered other issues and improvements that could enhance lab function, such as combining materials in areas where they were most frequently accessed and used. In March 2006, the cath/specials lab remodel was completed, our new Infinix DP-i/FD2 vascular X-ray system was installed, and our newly renovated lab was opened. The result is an efficiently designed room capable of even the most complex cardiac and vascular procedures. In fact, using our new system, clinicians are able to easily conduct a larger array of interventional radiology, vascular and cardiac procedures, including acute myocardial infarction intervention, pacemaker placement, liver biopsies, angiograms, catheter placements, TIPS, embolizations, spine interventions and intravascular and renal artery stenting. The transition to our new cath/specials lab was practically seamless. Toshiba worked with us for two weeks to ensure that we utilized the system to its fullest degree, and were comfortable with the technology. Our new lab also addressed many of our concerns about overall workflow specifically improving the flow of personnel and foot traffic in the lab. For instance, the nursing area has been relocated to the side of the room where procedural sedation medications are administered to the patient. Additionally, all the nursing supplies, medication, clinical charting, ACT testing and other nursing items were transferred to the same side of the room, providing easy access for the nursing staff. In addition, the new design called for all wires and stents to be located on the side of the room occupied by our technologists and physicians. While these changes were slight, they significantly improved the way we are able to work within our new space. A New Level of Exposure In addition to the obvious patient care and clinician-efficiency improvements, our new cath lab has helped raise awareness about St. Francis Hospital in the community. We have seen a noticeable increase in our referral base. Physicians have noted that they can see bones and anatomy with extreme clarity. While it was expected that the cath/specials lab’s new efficient design would increase our overall patient throughput, the speed of our new Infinix system has had a significant impact on the time it takes to complete procedures. This allows us to add two additional patients per day to our schedule, representing nearly a 25 percent increase in the number of cases we were doing previously. Because the new lab design is so impressive and we have received so much positive feedback, Toshiba has included St. Francis Hospital on its roster of showcase sites, which allows non-affiliated clinicians to view our new lab and vascular X-ray system in a practical setting. As an added bonus, this distinction has made our center more prominent in the community and improved the way we are able to market ourselves. Overall, we feel that the careful planning devoted to our new lab during the early stages of the project has given our staff a functional room they will enjoy far into the future. Author Peggy Coltrin can be contacted at peggycoltrin@fhshealth.org

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